CMS Announces Vaccine Coverage for Children Ages 5-11

Following the U.S. Food & Drug Administration’s (FDA) recent action authorizing the Pfizer-BioNTech COVID-19 Vaccine for the prevention of COVID-19 in children 5 through 11 years of age and a recommendation from the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS) is reminding eligible consumers that coverage is available without cost-sharing under Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and in the commercial market for this critical protection from the virus. 

As with all vaccines, the Pfizer-BioNTech COVID-19 Vaccine was tested thoroughly in this age group prior to its authorization for emergency use. While the effects of COVID-19 for a child can last for several months, the most commonly reported side effects of the COVID-19 vaccine in the clinical trial participants were generally mild to moderate in severity, and most went away within one to two days.

“The COVID-19 vaccine is the best way to keep children safe. The strongest protection against COVID-19, including the Delta variant, is to get vaccinated,” said CMS Administrator Chiquita Brooks-LaSure. “I encourage parents everywhere to talk with their pediatrician, school nurse, or other trusted healthcare provider about any questions they may have and to get their children vaccinated as soon as possible.” 

Nearly all Medicaid and CHIP beneficiaries are eligible to receive coverage of COVID-19 vaccines and their administration without cost-sharing. Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance, or deductible. COVID-19 vaccines and their administration will also be covered without cost-sharing for eligible consumers of most issuers of health insurance in the commercial market. People can visit vaccines.gov (English) or vacunas.gov (Spanish) to search for nearby locations to receive a vaccine.

Additionally, under the terms of the CDC COVID-19 Vaccination Program Provider Agreement, health care providers and other entities administering COVID-19 vaccines must agree not to deny anyone a COVID-19 vaccination based on their health coverage status, and must also agree to administer COVID-19 vaccines at no out-of-pocket cost to recipients.